How to pick the right over the counter meds

Sick of being sick?
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The question
This year, flu season started late and allergy season came early. There are so many choices and combinations of cold, flu, sinus and allergy medicines at the drug store — it’s confusing. How do I know what to take?

Choosing an over-the-counter (nonprescription) remedy for what ails you generally depends on the cause and type of symptoms you experience. Cold and flu viruses generally cause illness that may be characterized by fever, headache, body aches, nasal congestion, sore throat and coughs. Symptoms usually follow an up-and-down course over seven to 10 days, and resolve completely after 14 to 21 days.

Seasonal allergies, also known as Hay Fever, are the body’s immune response to environmental irritants — usually tree and flower pollen in the spring. Red or itchy and watery eyes, nasal congestion, sneezing and a dry cough may plague allergy-sufferers.

Over-the-counter remedies are generally divided and marketed by the symptom(s) they treat. Many products combine ingredients, so you might see the following on a label: “Cold and Flu,” “Cold and Sinus,” “Cold and Cough,” “Sinus and Pain,” “Allergy Sinus,” etc. This is where confusion comes in.

It is important to be familiar with the individual ingredients in each product, so that you treat the symptoms of your illness or allergy appropriately. Take only the medication needed for your symptoms, and don’t accidentally overdose with a double dose if there is overlap between products. Knowing what medications are safe to take with underlying medical conditions is also important, so always ask your doctor or pharmacist before taking an over-the-counter remedy.

These symptoms all result from inflammatory substances released by white blood cells that fight infection or respond to allergy-inducing pollen. Acetaminophen (Tylenol), aspirin and non-steroidal anti-inflammatory drugs (NSAIDS) like ibuprofen (Advil or Motrin) and naproxen (Aleve) are the most common drugs for relieving these systemic symptoms. They work by blocking various chemicals that cause inflammation and pain.

Decongestants: Relief of nasal congestion from colds and allergies is accomplished by drugs that shrink the blood vessels and decrease swelling in irritated nasal passages. These come in tablet and nasal spray form. Pseudoephedrine and phenylephrine are the most common oral forms (the “D” in combination products). Oxymetazoline (Afrin) and neo-synephrine are the most common spray ingredients.

Antihistamines: Histamine is a chemical released by cells fighting allergies and infections, causing increased secretion of mucous in airways. Antihistamines help to block the production and release of histamine, thereby decreasing secretions. These come in oral tablets and liquids, nasal sprays and eye drops.  Common drugs include the old school “drowsy” variety (the “P.M.” in combo products) diphenhydramine (Benadryl), chlorpheniramine, brompheniramine and doxylamine, and non-drowsy forms like loratadine, cetirizine and fexofenadine (Claritin, Zyrtec and Allegra, respectively).
Expectorants and cough suppressants: An expectorant makes mucous secretions more watery and easier to expel when you cough or blow your nose. The most common expectorant in capsules and liquids is guaifenesin (Robitussin or Mucinex). Dextromethorphan (“DM” in combo products) is a synthetic codeine-like substance that decreases the sensitivity of the coughing reflex,  suppressing the urge to cough.

If you are sick or suffering from allergies and are unsure about what to take, ask your pharmacist for a recommendation or advice. Pharmacists are trained professionals and should be happy to help you decide.

— Mark Melrose, DO, is a board-certified emergency physician at Urgent Care Manhattan. E-mail him your questions at

Metro does not endorse the opinions of the author, or any opinions expressed on its pages.


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